BACKGROUND: Chronic idiopathic constipation (CIC) is a functional gastrointestinal disorder characterized by symptoms of difficult, infrequent or incomplete defecation. The prevalence of CIC in the United States (US) is 4–20%1,2 and it is associated with a substantial economic burden. This systematic review aimed to evaluate the healthcare resource use (HCRU), direct costs and indirect costs associated with CIC, and the cost-effectiveness of prescribed treatments for CIC in the US.
METHODS: Electronic databases (PubMed, Embase, Cochrane Library, Econlit and CINAHL) and health technology assessment (HTA) websites were searched for studies reporting the economic burden of CIC (January 1 2006–March 1 2017). In addition, recently published congress abstracts were screened (January 1 2015–March 1 2017).
RESULTS: Of 345 articles identified, four met the inclusion criteria and reported data from the US. Two studies presented data on US HCRU and direct costs. Of these studies, one reported higher mean adjusted predicted inpatient and emergency room (ER) costs over a 2-year period in patients younger than 65 years old with CIC compared with those without CIC (inpatient costs: $10 723 vs $8439, respectively; ER costs: $2231 vs $1646, respectively). The second study reported that one third of patients with CIC incur additional annual costs in the range of $40–$400 from the use of complementary alternative medicines, such as herbal tea or acupuncture. One study investigated indirect costs of CIC in the US, and reported that patients with CIC and abdominal symptoms missed a greater number of work or school days per month than those with CIC and no abdominal symptoms (0.8 vs 0.4 days per month, respectively). In addition, patients with CIC and abdominal symptoms experienced a greater number of days of disrupted productivity per month than those with CIC and no abdominal symptoms (3.2 vs 1.2 days per month, respectively). One study on the cost-effectiveness of treatment from a US perspective was identified, and reported a lower direct cost per patient for linaclotide ($946) than for lubiprostone ($1015); however, quality adjusted life years were the same for both treatments. No publicly available US-based utility studies were identified.
CONCLUSIONS: Available data suggest that patients with CIC have higher HCRU and direct and indirect costs than patients without CIC. Lower productivity and higher absenteeism were reported in patients with CIC and abdominal symptoms compared with those with CIC without abdominal symptoms.
